In-Home CKD Care Manager RN

Monogram Health, Inc.; Trenton (NJ); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Competitive compensation

Performance-based bonus

Full benefits package (medical, dental

Job summary

Monogram Health is seeking a skilled Registered Nurse to join our Care Management team as a Care Manager RN. You will lead in-home care for a small panel of CKD/ESRD patients, coordinating with physicians, pharmacists, and social workers to slow disease progression and improve quality of life.

The role requires BLS, RN licensure in the posted state, and 2+ years in care management, with local travel and some nights/weekend on-call. Competitive pay and comprehensive benefits provided.

Qualifications

• Graduate of an accredited School of Nursing.
• Currently licensed as a Registered Nurse in the state of the posted location.
• 2+ years experience in care management and/or with CKD/ESRD patients.
• BLS certification required; company will support certification on onboarding.
• Frequent local travel for in-home visits; on-call some nights and weekends.

Responsibilities

• Work closely with patients’ medical providers to develop and continually adapt care plan.
• Perform in-home care management visits to execute care management plan.
• Monitor biometric data and follow approved protocols for any necessary interventions.
• Inventory and reconcile medications and coordinate with pharmacists and prescribers.
• Perform patient health assessments and surveys as required.
• Deliver education on CKD, ESRD, dialysis and related comorbidities.
• Encourage medication adherence through frequent contact with patients.
• Engage family and social support groups in patient education and care.
• Serve as the primary contact and be the first call during business hours.
• Provide education around medications, conditions, diet, exercise, and lifestyle decisions.
• Educate patients and facilitate Advance Care Plans and ESRD treatment discussions.
• Obtain vital signs during visits and escalate concerns to the provider.
• Onboard patients and manage enrollment processes.
• Perform post-op and hospital discharge visits to support transitions.
• Review and document patient progress in the care management platform.
• Coordinate with dialysis providers to ensure seamless transitions of care.

Skills

Empathy and relationship-building

Excellent verbal communication

Self-starter with independence

In-home visit readiness

Education

Graduate of an accredited School of Nursing

Tools

Microsoft Office

Job description

Monogram Health is seeking a skilled Registered Nurse to join our Care Management team as a Care Manager RN. You will lead in-home care for a small panel of CKD/ESRD patients, coordinating with physicians, pharmacists, and social workers to slow disease progression and improve quality of life.

The role requires BLS, RN licensure in the posted state, and 2+ years in care management, with local travel and some nights/weekend on-call. Competitive pay and comprehensive benefits provided.